Cybersecurity Change Request (CR)

In accordance with IACS UR E26 §5.3.1 & UR E22 Section 6

Doc ID: TAG-OT-MOC-01
Version: 1.3 (IACS E22 Compliant)

Vessel / Hull #:		Date:
Requestor / Rank:		E22 Stakeholders:	OEM Agreed Owner Agreed

IACS Category:	Cat I	Cat II	Cat III (High Criticality)
Impact Scope:	Documentation Only	Logic / Firmware	Network / Firewall

Regression Test: Verified that modification has NO negative impact on unrelated functions?
Rollback Simulation: Recovery path to previous stable version confirmed?
Master Files: Software master files updated and stored by Personnel Authority?
Configuration backup / “Gold Copy” successfully stored offline?
MAC Address / Asset ID updated in Master Inventory?
Functional test performed and witnessed per OEM requirements?

Class Society Notified (Date: ) | Reference ID:

Authorized by (DPA / Master):

Signature & Date

Technical Verification (ETO / Tech Manager):

Signature & Date